In 21 states, residents saw well-being scores decline last year in the Gallup-Sharecare Well-Being Index. Scores in the other 29 states stayed the same. And, for the first time in nine years of the pollsters tracking changes in well-being by state, not a single state state saw improvement from the year before.

What were the states with the most satisfaction? South Dakota and Vermont tied for the top spot, with Hawaii -- a regular in the top five -- close behind. Minnesota came in fourth, and North Dakota was fifth.

South Dakota’s low unemployment rate of 3.5 percent likely helped propel the state into the top five for financial and community well-being. South Dakotans reported few major worries and little stress on any given day and said they like what they do. Vermonters said they find deep satisfaction with their relationships.

West Virginia has the lowest well-being, followed by Louisiana. West Virginia is usually at the bottom of the list, according to Gallup. The state’s already high obesity and diabetes rates contribute to the lack of satisfaction with quality of life there, and the fact that the state is home to some of the worst problems of the nationwide opioid epidemic, including a 21 percent increase in opioid-related overdose deaths in a year, is a contributing factor.

States with historically high satisfaction that have progressively dropped include Arkansas, Georgia, Missouri, Mississippi, North Carolina, Ohio, Pennsylvania, South Carolina, Texas and Virginia.

The survey quizzes more than 160,000 Americans and factors in a lot of variables when it comes to defining “well being,” including:

Purpose: liking what you do each day and being motivated to achieve your goals

Community: liking where you live, feeling safe and having pride in your community

Physical: having good health and enough energy to get things done daily

Overall, those surveyed generally reported more worry, little interest in doing things, symptoms of depression and perceiving less “positive energy” from family and friends. Fewer people reported having someone in their lives who makes them “enthusiastic about the future.” There was also a decline in the number of Americans who said they are reaching their goals and are happy with their standard of living.